A Crisis of Trust: A Case Study of Doctor–Patient Relationship in Guangzhou

Author(s):  
Mani Shutzberg

AbstractThe commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms of solidarity between comrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice.


2020 ◽  
Vol 33 (3-4) ◽  
pp. 66-84
Author(s):  
Rachel Weitzenkorn

This article argues that the foundational separation between psychoanalysis and experimental psychology was challenged in important ways by psychoanalytic infant researchers. Through a close examination of American psychoanalyst René Spitz (1887–1974), it extends John Forrester’s conception of reasoning in cases outside classic psychoanalytic practices. Specifically, the article interrogates the foundations of reasoning in cases—the individual, language, and the doctor–patient relationship—to show how these are reimagined in relation to the structures of American developmental psychology. The article argues that the staunch separation of experimental psychology and psychoanalysis, reiterated by philosophers and historians of psychology, is flimsy at best—and, conversely, that the maintenance of these boundaries enabled the production of a cinematic case study. Spitz created films that used little language and took place outside the consulting room with institutionalized infants. Yet key aspects of the psychoanalytic case, as put forth by John Forrester, were depicted visually. These visual displays of transference, failure, and interpersonal emotions highlight the foundations of what Forrester means by reasoning in cases. The article concludes that Spitz failed at creating classic psychoanalytic evidence, but in so doing stretched the epistemology of the case.


1995 ◽  
Vol 25 (4) ◽  
pp. 319-329 ◽  
Author(s):  
Peter Salmon ◽  
Carl R. May

Objective: Extensive empirical data and theory describe the inequality of power in relations between doctors and their patients. However, the focus has been on the ways in which doctors control the doctor-patient relationship. This has meant that the extent to which patients influence the consultation, and the ways in which they do this, have been neglected. Methods: In this article, we use a single case to identify and illustrate distinct ways in which patients exert power to determine the outcome of consultations. Conclusion: This analysis leads to a more powerful explanation than is presently available to understand the somatization of psychological needs. According to this, the patient organizes strategies, which include the presentation of emotional and social distress, around a biomedical model. Because of their prior decisions as to their role, doctors permit themselves to be trapped in this model.


2018 ◽  
Vol 2 (1) ◽  
pp. 19
Author(s):  
Luiz Alberto Queiroz ◽  
Nara Lima Alexandre

Background: Medicine has been gaining high technological power, essential for many diagnoses and current treatments. On the other hand, one observes the distancing of the physician from what should be his instrument of work: the person.  Bahiana School of Medicine has been implementing actions aimed at integrating the student into the subjective elements of medical practice through such subjects as the Psychodynamics of the Medical Clinic. Objectives: To portray the reality of the teaching of the discipline Psychodynamics in the Bahiana School of Medicine and Public Health; to evaluate the performance of the psychodynamic material taught in the 7th semester of the medical course, as well as the need to teach humanistic fundamentals to the student community of this school. Methods: Case study conducted through documentary analysis, interview with professor of the subject and application of questionnaire. After approval by the Ethics Committee, questionnaires containing sex, age, year of the course, questions related to the subjects developed in the subject were applied, such as doctor-patient relationship, death and dying, medical vocation and humanization etc. Results: The goal of psychodynamics is to provide an integral view of the patient. The questionnaires were answered by 124 students distributed between the 4th, 5th and 6th grades. 88.7% agreed that the subject provided grounds for establishing an effective physician-patient relationship. 91.2% agreed that the subject drew attention to the therapeutic aspect that can have the doctor-patient relationship. 99.2% agree that in order to meet humanity, it is first necessary to humanize. 86.3% of the students agree on the need to teach humanistic fundamentals throughout the course. Conclusions:A Psicodinâmica da Clínica médica vem atingindo os objetivos propostos. Há necessidade do ensino de fundamentos humanísticos durante todo curso de medicina.Background:Medicine has been gaining high technological power, essential for many diagnoses and current treatments. On the other hand, one observes the distancing of the physician from what should be his instrument of work: the person.  Bahiana School of Medicine has been implementing actions aimed at integrating the student into the subjective elements of medical practice through such subjects as the Psychodynamics of the Medical Clinic. Objectives:To portray the reality of the teaching of the discipline Psychodynamics in the Bahiana School of Medicine and Public Health; to evaluate the performance of the psychodynamic material taught in the 7th semester of the medical course, as well as the need to teach humanistic fundamentals to the student community of this school. Methods: Case study conducted through documentary analysis, interview with professor of the subject and application of questionnaire. After approval by the Ethics Committee, questionnaires containing sex, age, year of the course, questions related to the subjects developed in the subject were applied, such as doctor-patient relationship, death and dying, medical vocation and humanization etc. Results: The goal of psychodynamics is to provide an integral view of the patient. The questionnaires were answered by 124 students distributed between the 4th, 5th and 6th grades. 88.7% agreed that the subject provided grounds for establishing an effective physician-patient relationship. 91.2% agreed that the subject drew attention to the therapeutic aspect that can have the doctor-patient relationship. 99.2% agree that in order to meet humanity, it is first necessary to humanize. 86.3% of the students agree on the need to teach humanistic fundamentals throughout the course. Conclusions: A Psicodinâmica da Clínica médica vem atingindo os objetivos propostos. Há necessidade do ensino de fundamentos humanísticos durante todo curso de medicina.


2001 ◽  
Vol 120 (5) ◽  
pp. A735-A735
Author(s):  
C STREETS ◽  
J PETERS ◽  
D BRUCE ◽  
P TSAI ◽  
N BALAJI ◽  
...  

2019 ◽  
Vol 1 (1) ◽  
pp. 40-50
Author(s):  
Jose Luis Turabian

Psychology and sociology share a common object of study, human behaviour, but from different perspectives. Sociologists have focused on macro variables, such as social structure, education, gender, age, race, etc., while psychology has focused on micro variables such as individual personality and behaviours, beliefs, empathy, listening, etc. Despite the importance of interpersonal relationship skills, they depend on the community or social context in which communication takes place, and by themselves may have little relevance in the consultation. The purely psychological analysis of the doctor-patient relationship often leads to an idyllic vision, with the patient-centred consultation as the greatest exponent, which rarely occurs in real life. The purely sociological or community / social analysis of the doctor-patient relationship leads to a negative view of the consultation, which is always shown as problematic. But, the psychological system in the doctor-patient relationship cannot be neglected, and its study is of importance, at least as an intermediate mechanism that is created through socio-community relations. Although the same social causes are behind the doctor-patient relationship, when acting on psychological factors in the consultation, they act as an optical prism scattering socio-community relations that affect the doctor and the patient, giving rise to a beam of different colors of doctor-patient relationship. In doctor-patient relationship there is a modality of psychotherapy, where attitudes, thoughts and behaviour of the patient, can be change, as well as it can be extended on the way of understanding and therefore changing, his social context. Because of the distance between socio-community relations and the form of doctor-patient relations is growing in complex societies, under these conditions, the sociological factor gives the important place to the psychological factor. Given these difficulties of the doctor-patient relationship one may ask how general medical practice can persist with the usual model of doctor-patient relationship. Pain and the desire to relieve them are the basic reasons for the patient and the doctor, and they do not disappear due to the contradictions of the doctor-patient relationship. In this way, the confrontation between sociological and psychological vision is replaced by an alliance of both currents, and each of them takes on meaning only in the general vision.


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